Association between contact precautions and delirium at a tertiary care center

Abstract

Objective: To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors.

Design: Retrospective cohort study.

Setting: A 662-bed tertiary care center.

Patients: All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009.

Methods: Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center.

Results: During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24-1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60-1.92]; P < .01) and was not seen in patients who were already under contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86-1.09]; P = .06).

Conclusions: Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.

FIGURE 1

Flowchart for selection of the study population and determination of delirium using a surrogate marker. GEE, generalized estimating equation.